My Specialty

Medical-Surgical Nursing

Variety: the spice of this specialty

Adult health care is a complex and sophisticated area of specialization, but there's one kind of nurse who can meet it head on and come back the next day for more. A medical-surgical nurse, of course. Though it was long thought of as a step toward a real specialty, today we rightly see medical-surgical nursing as a separate area of concentration, all by itself. These nurses have their own professional organization, their own certification and their own identity. While a practitioner might focus on one disease or surgical subspecialty, most nurses in this category can and do cover many bases.

The Tasks at Hand

Even as a majority of care moves from inpatient to community settings, medical-surgical nurses still form the backbone of the staff at almost all medical facilities, and they constitute — by far — the largest group of nurses: about 400,000 out of 2.9 million registered nurses in the United States, according to Kathleen Singleton, RN, MSN, CNS, CMSRN and president of the Academy of Medical-Surgical Nurses.

Singleton's specialty is medical-surgical nursing, and she sees it as her true love despite a lengthy foray into critical care early in her career. “I discovered I prefer working with patients who are able to participate in and make decisions about their own care, both now and for the future,” she said.

For a while she taught in a baccalaureate program, but, as many point out, the money is not even close to what hospital nursing pays. For many practitioners the disparity is prohibitive. Now her role, which includes education, consultation and administration, brings her back to the acute care bedside, which is where 82 percent of the AMSN membership practices.

According to Singleton, you will find med-surg nurses anywhere adults seek care. These nurses bring a, “broad base of knowledge, which they use to monitor trends and detect subtle changes in patients under their care,” she said. They care for patients with acute conditions and chronic illness, often at the same time, in the same patient. And because they deal in episodic events and chronic conditions, they always forge new relationships with their patients.

On any given day, a medical-surgical nurse must be in command of the top five or six interventions for up to 10 different conditions. Such a nurse also represents the core of nurses who work in health and wellness spheres — parish, office and clinic nurses, for example.

What makes these nurses special? And what makes this field so challenging? Most of them can care for patients across many age levels (centenarians are no longer rarities), with different degrees of acuity, and with a huge variety of disease categories. They often spend their days managing the care for five to seven patients; they also routinely add new patients and discharge recovered ones throughout the day. Rapid course changes occur so often that they become part of the routine. Whether they work in a facility that uses primary care nursing or in one that uses RNs as team leaders, at the end of the day, the registered nurse is responsible for the care that patients receive.

Skills & Certification

According to Singleton, the specialty requires a specific set of skills, and because of rapid changes in health care today, skill acquisition is not easy. Do you remember just how thick and heavy that basic text was? No nursing program can adequately cover everything. Each graduate needs some sort of mentoring, preceptorship, residency or internship.

Think about it, she said. When she first began nursing, there was essentially one “water pill.” Now there are dozens. The average inpatient receives 10 to 12 medications. “There are 45 names for potassium alone.” Patients formerly cared for in the acute setting are “sitting in their living rooms with home care.” And acute care floors have a population that 10 years ago would have been in ICU. Telemetry, once seen only in critical care units, is now part of routine medical-surgical care. Medical-surgical nursing, while it may have once been the stepping stone to other specialties, now has a changed dynamic — one that is very much its own.

For many nurses, medical-surgical nursing is a career choice and a source of personal and professional fulfillment. In the past six years, 10,000 nurses have qualified for the designation CMSRN, granted by AMSN. Singleton notes that as more and more hospitals strive for Magnet certification, and as they try to quantify professional skill sets for public disclosure, the demand for certified nurses will surely increase.

Certification as a medical-surgical nurse can come from several sources. The AMSN recognizes only its own designation — CMSRN. It is granted after the nurse has documented two years of experience and 2,000 hours in medical-surgical nursing care. Another part of the certification process is the test, administered year-round via computer. On occasion, certification is possible without retaking the test if the nurse earned a different certification from another organization.

The American Nurses Credentialing Center also provides validation through its program leading to an RN-BC. Requirements are similar to AMSN, although a slightly different philosophy prevails in each organization, according to Singleton.

Getting Experience

It is, of course, possible to work without certification. After all, it takes a while to add up those hours and to get the requisite two years' experience. Elena Padilla, RN, is a 2008 graduate of Victor Valley College. She is now working at Pomona Regional Medical Center and isn't so far out of school that she can't remember what it was like to be a student — and how being a nurse is different. Since graduation she has worked on a neurosurgical floor that has a large group of patients with recent laminectomies. The staff also sees a considerable number of patients with cerebrovascular events.

What she loves about this unit and this job is the tremendous variety and varying acuity of the patient mix. She needs to handle routine postoperative issues like pain relief and positioning; but she also needs to understand all the underlying and pre-existing conditions that patients may have, including diabetes, pressure ulcers and hypertension.

At Pomona the nurses are lucky enough to do primary care nursing and are usually responsible for five patients. On any given day, Padilla may have two to three different attendants helping her with specific patients, but the primary responsibility is hers. Education of the attendants and the patients is very important; often, too, it is the spontaneous, on-the-spot instruction that all nurses must master. Or it can be a more formal type of teaching involving written protocols like discharge instructions. Delegation and supervision of attendants is essential, even for a new graduate.

Her orientation was fairly typical of new grads in medical-surgical nursing. She was assigned a preceptor and a small number of patients until she felt able to handle a normal patient load. It took approximately three months. Today, her resources for advice and help with clinical problems are fellow staff nurses, the unit manager and the clinical supervisor.

Does she have another kind of nursing in mind for the future? Maybe emergency department nursing, “but not for a very long time,” she said. “Every day I learn new things, and I really enjoy the challenge right here.” Most of the patients have multiple problems. The toughest one she confronts will sound familiar to all nurses. In her words, “I wish I had better communication and more time with my patients. By the time I do assessments and give medications, it is time to move on to the next one.” Computers and a new system at Pomona, E-Med, save time, but it seems more is always needed.

What is her greatest satisfaction? It has to be, “going home and knowing that I was able to help at least one patient get better,” she said.

If you are thinking of this specialty, be aware that you will have endless challenges and endless variety. You’ll master skills that you will use throughout your nursing career, including leadership, organization, time management and, not least, all the nitty-gritty nursing procedures you could ever think to use. You will be able to take those skills to almost any facility at any time and get a good job. And each day you go to work, you will know you have the chance to make someone feel better. So whether it is a solid career choice or a stepping stone to another field, medical-surgical nursing offers opportunity.